Provider Demographics
NPI:1548532658
Name:JALILVAND, ZAKIAT NUR-DAROJAT (DO)
Entity type:Individual
Prefix:DR
First Name:ZAKIAT
Middle Name:NUR-DAROJAT
Last Name:JALILVAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ZAKIAT
Other - Middle Name:NUE
Other - Last Name:DAROJAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:32742 COPPERCREST DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3373
Mailing Address - Country:US
Mailing Address - Phone:949-923-0608
Mailing Address - Fax:
Practice Address - Street 1:30212 TOMAS STE 180
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2174
Practice Address - Country:US
Practice Address - Phone:949-923-0608
Practice Address - Fax:855-326-5678
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12141208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine